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Novel CAD/CAM-splint-based navigation protocol enhances intraoperative maxillary position control in orthognathic
Felix Schrader1, Leonardo Saigo2, Norbert Kübler1
1Department of Oral and Maxillofacial Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
Head & Face Medicine
|January 10, 2025
Summary
This study shows that surgical navigation with modified CAD/CAM splints improves accuracy in orthognathic surgery. This novel, non-invasive method enhances maxillary positioning for better patient outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Medical Technology
- Surgical Navigation
Background:
- Traditional orthognathic surgery plan transfer uses CAD/CAM occlusal splints or patient-specific implants (PSI).
- CAD/CAM splints have accuracy limitations, especially vertically, while PSIs are costly and time-consuming.
- Existing surgical navigation protocols often involve invasive registration or lack transparent evaluation.
Purpose of the Study:
- To introduce and assess a novel protocol for point-based optical surgical navigation using modified CAD/CAM splints.
- To evaluate the effectiveness of this non-invasive navigation method for intraoperative maxillary positioning.
- To compare the accuracy of surgical navigation with standard CAD/CAM splints in orthognathic surgery.
Main Methods:
- A prospective case-control study involving 20 patients undergoing bimaxillary orthognathic surgery.
- An experimental group used surgical navigation with modified CAD/CAM splints; a control group used standard CAD/CAM splints.
- Surgical accuracy was assessed by measuring translational and rotational discrepancies between planned and achieved maxillary positions.
Main Results:
- Surgical navigation significantly improved accuracy in x-axis translation (p=0.021) and z-axis translation (p=0.014), and yaw rotation (p=0.045).
- Other movements showed improved precision in the navigated group, though not all reached statistical significance.
- The amount of planned movement significantly impacted surgical accuracy, independent of navigation use.
Conclusions:
- Surgical navigation with modified CAD/CAM splints enhances accuracy in orthognathic surgery without invasive procedures.
- This protocol offers a straightforward, transparent method for intraoperative evaluation of maxillary positioning.
- Further research is needed on clinical significance and cost-effectiveness compared to PSI, with potential for future mixed reality integration.
